Highlights from key sexual health policies across state legislatures.
April 30, 2023
This Month in State Policy
NCSD’s This Month in State Policy is a corresponding series intended to complement state-specific policies outlined regularly in This Week in Congress. NSCD will post This Month in State Policy through early June to provide peak coverage and analysis of state legislative sessions. For more information about this summary or other state policy trends, please contact NCSD’s Policy Team.
Expedited Partner Therapy:
Kentucky lawmakers nearly unanimously passed legislation expanding Expedited Partner Therapy (EPT) to include trichomoniasis (previous language specified chlamydia and gonorrhea only). EPT is a clinical practice that authorizes providers to treat partners of patients diagnosed with an STI without examining their partner first, i.e., expediting treatment. EPT intends to improve STI treatment by removing barriers that may prevent a patient’s partner from getting tested on their own, such as disclosure concerns or lack of provider access; Gov. Andy Beshear (D) signed the bill into law last month.
State Rep. Patty Lewis (D-MO) introduced legislation for the second year in a row that mirrors Kentucky by adding trichomoniasis to the state’s EPT law. As of the date of this publication, the bill has yet to make it out of committee.
Kentucky’s HB349 did not only expand EPT; it also removed Class D Felonies for People Living with HIV (PLWH) who are organ donors. HIV advocates have historically argued that policies stigmatizing and/or prohibiting organ transfers between individuals living with the virus exacerbates existing health inequities for a community already facing a limited donor pool.
Lawmakers in Oklahoma advanced SB292, which would expand testing and remove cost-sharing requirements for syphilis screening in pregnant people. Initial language in the bill passed by the state Senate included three-part testing requirements: at the first prenatal visit, at the third trimester (28-32 weeks’ gestation), and at delivery. The Oklahoma House version changed language to require serological testing for syphilis as indicated by current Center for Disease Control and Prevention (CDC) STI treatment guidelines, which recommend retesting pregnant patients after the first visit if they live in a community with high syphilis rates or are considered at-risk. Maternal risk factors for syphilis include using drugs, having multiple sex partners, trading sex for something of value, or experiencing incarceration or homelessness.
Both versions maintain the requirement that health benefit plans must cover the costs of syphilis screenings for people during pregnancy. While some state policymakers have expanded syphilis screening laws, regulatory language differs across jurisdictions. The CDC recently released STI data from 2021 that showed historically high congenital syphilis rates, reinforcing that the ongoing crisis demands refined policy intervention.
STI Insurance and Treatment Coverage:
SB132 in New Mexico and SB189 in Colorado both became state law in April, eliminating insurance cost-sharing for STI treatment. However, both plans exclude high-deductible health plans and therefore, expanded access to STI treatment that will vary based on the type of insurance a person selects.
Similarly, State Sen. Dallas Harris (D-Nev.) introduced legislation to eliminate cost-sharing for STI treatment. The bill includes other provisions and protections, such as requiring operators of prisons, jails, or detention facilities to provide HIV treatment or prevention medications to people who are incarcerated.
Protections for Abortion and Gender-Affirming Care:
Colorado joined Illinois as a “service peninsula” by enshrining protections for abortion while bordered by three states with significant restrictions or prohibitions. SB188, signed into law by Gov. Jared Polis (D), prohibits insurance carriers from terminating network contracts with licensed providers based solely on their willingness to offer a service the state legally recognizes, such as abortion or gender-affirming care.
The same legislation also restricts outside probes from other states for any clinical services lawfully obtained. In addition to this, the Colorado governor signed SB190, which clarifies that it is a deceptive trade practice to falsely advertise abortion services while knowingly not offering such services—a tactic Crisis Pregnancy Centers have been accused of exploiting to deliberately create patient confusion. The bill also classifies abortion pill reversal interventions as “unprofessional conduct.”
NCSD has been following parental rights legislation, including its impact on LGBTQ youth, sex education, and minor consent laws.
Iowa legislators in both state chambers passed SF496, which among other rules establishing age-appropriate school materials and curriculum, would remove HPV and the availability of the vaccine to prevent HPV from the health curriculum for seventh and eighth graders. Per the CDC’s Advisory Committee on Immunization Practices, HPV vaccines are recommended for children aged 11 or 12 years. NCSD released a statement about the importance of HPV education earlier this year, emphasizing the decision to eliminate it puts the safety of adolescents at risk.
In addition to striking vaccine information, SF496 would require that parents are notified if their child requests “an accommodation intended to affirm the student’s gender identity.” In the face of similar laws replicating across the country, transgender youth advocates have argued such “forced outing” legislation makes schools unsafe and puts LGBTQ+ youth in vulnerable positions.
However, not every effort to restrict transgender rights has been successful. In a direct move to oppose similar legislation, state Sen. Machaela Cavanaugh (D-Neb.) has continued a weeks-long filibuster, preventing the bicameral legislature from passing any bills at all. The bill that inspired her filibuster is LB574, which would prohibit gender-affirming care for anyone in Nebraska under age 19.